External sensory panel recruitment questionnaire

Please complete the following questionnaire. All information given will remain confidential.

Step 1 of 7

14%

Name*

FirstLast

Date of birth*

Phone*

Email*

Enter EmailConfirm Email

Address*

Street AddressSuburbStatePostcodeCountry

Age group*

18-24

25-34

35-44

45-54

55-60

+60

Gender*

Female

Male

Nationality*

Education background*

Current occupation*

How did you hear about this position?*

Are you in general good health?*

Yes

No

If 'No' is selected, please give details.

Have you ever suffered an allergic reaction to wine or any wine related products?*

No

Yes

If 'Yes' is selected, please give details.

Please Indicate which, if any, of the following foods disagree with you (allergy, discomfort, etc):

Cheese

Chocolate

Eggs

Fruits

Meats

Milk

Poultry

Seafood

Spices

Nuts

Vegetables

Do you have any other allergies?*

No

Yes

If 'Yes' is selected, please give details.

Please indicate your dietary requirements:*

No special diet

Diabetic

Low Salt

Other dietary requirements

Are you taking any medications that affect your senses?*

No

Yes

If 'Yes' is selected, please give details.

Are you colour-blind?*

No

Yes

Are you on any other sensory panels?*

No

Yes

If yes, please provide information on what sensory panels are you on.

What is your current availability? (tick all that apply)*

Monday AM

Monday PM

Tuesday AM

Tuesday PM

Wednesday AM

Wednesday PM

Thursday AM

Thursday PM

Friday AM

Friday PM

Would you be able to commit to at least one year of participation on the panel?*

No

Yes

Comments

How often do you drink wine?*

Never

Occasionally

Once a week

Two or three times a week

More than three times a week

What type of wine do you drink?*

Mostly white wine

Mostly red wine

Both equally

Neither

The following is a list of wine types of current, or potential interest to us. Using these descriptions please rate each wine type by circling the number on the scale that most closely describes your attitude towards it.

Sparkling wine*

Dislike extremely

Dislike

Neither like or dislike

Like

Extremely like

Aromatic White Wines (e.g. Rieslings, Sauvignon Blanc)*

Dislike extremely

Dislike

Neither like or dislike

Like

Extremely like

Sweet White Wines (e.g. Moscat)*

Dislike extremely

Dislike

Neither like or dislike

Like

Extremely like

Rosé*

Dislike extremely

Dislike

Neither like or dislike

Like

Extremely like

Dessert Wines (e.g. botrytis Semillon)*

Dislike extremely

Dislike

Neither like or dislike

Like

Extremely like

Light Bodied Red Wines (e.g. Pinot Noir)*

Dislike extremely

Dislike

Neither like or dislike

Like

Extremely like

Full Bodied Red Wines (e.g. Shiraz, Cabernet Sauvignon)*

Dislike extremely

Dislike

Neither like or dislike

Like

Extremely like

Fortified Wines (i.e. Sherry, Port, etc)*

Dislike extremely

Dislike

Neither like or dislike

Like

Extremely like

Do you have a background in wine or any wine qualifications?*

No

Yes

If yes, (please specify)

How would you describe the flavour differences between a white and red wine?*